The Chief Medical Director of University of Ilorin Teaching Hospital(UITH), Professor Abdulwaheed Olatinwo, in this interview, speaks on healthcare delivery in the country. What is your assessment of health care delivery in Nigeria? I give thanks to God for the opportunity to serve. Health care delivery in the country has gone through several stages.

I remember during the the tenure of Professor Olikoye Ransome-Kuti as Health Minister, emphasis was on primary health care and invariably it got to the tertiary level. With the commencement of the present administration and the change process, it has been established that primary health care is key,but there is also the need to strengthen the secondary health care .Of course, we should be able to maintain the tempo at the tertiary level too. That means that government at different levels must perform its responsibility in the area of health care delivery.

The local government must perform the responsibility of ensuring effective primary health care delivery, the state government for secondary health care, like the General Hospitals, while the Federal Government concentrates on teaching hospitals. In our own case, more than 80% of the patients we treat are supposed to have been treated at the primary and secondary levels. But that is not so; and it is not good for the system and that is actually affecting our management system. Training,research and service, which are among our core mandate, have been tampered with because the bulk of our patients fall within the category of primary and secondary health care .

So, my take is that there must be functional General Hospitals. We must have a minimum of one functional General Hospital in each LGA in Nigeria. And, of course within 200 meters of each other, there must be primary health care facilities. This means that if everybody in the area registers at a primary care health facility, from there you go to the General Hospital. It is the ailment that they cannot solve that you bring to the teaching hospital. This will conserve more money and make health care delivery more effective. Discussions are ongoing about how to make rural health care effective. What's your vision for the University of Ilorin Teaching Hospital?

When I came here,i realised that there was the need for reorientation. The staff attitude was very poor because everybody looked at the job as government work, meaning that whether you worked or not, the possibility of getting your pay at the end of the month was very high. So, I embarked on re-orientation and we focused on patients because that is why we are here. What it simply means is that our performance rating would be decided from the perception of patients. And to achieve this, we organised workshops and seminars for the staff. From there, we moved to "ownership", meaning that you do the work as if it's your own. When you consider the fact that the next patient might be your relation, you are bound to guard the job jealously.

Then we moved to stewardship, whereby you are able to assess yourself and conclude that you have been able to do far more than what is expected of you. We also focus on what can workers give back to the system. And ours is a complex job because our customers are complex, they want their ailment to go immediately, so we taught the staff how best to speak with patients! So, it is from attitudinal change to massive transformation! Strike option has been indiscriminately used by unions in the medical field to press home their demands. What is your take on this? It is most unfortunate because it shows lack of sympathy .

I know the unions talk about human rights, but people also have the right to good medical care. And we have to understand that health is an essential service. You might say government has not given you enough money today. But if tomorrow, government gives you the money,how about the lives that have been lost during your strike? Who gives them back their lives? I think going on strike in hospitals is fundamentally wrong, we have to change the perception. Strike is a way to make government reason about workers demands, but there are other means. In fact, it must be after every other option has been exhausted that workers should go on strike. And, ideally, they are not supposed to go on strike when you check the Trade Dispute Act. Any worker that is on essential service cannot go on strike. Unfortunately, things have really degenerated badly. You can't really blame the unions, you blame government and the system to the extent that when agreements are reached, they are not implemented. But be that as it may,we should look at the larger perspective, that is, the patient.

The people are dying for a fault that is not theirs.I think it's important for us to have a rethink about going on strike in our hospitals. What are the challenges facing University of Ilorin Teaching Hospital? The major problem is dearth of support services. We are supposed to have electricity 24 hours everyday, but in the last two years or so, things have become so bad that we have not had electricity supply for two hours everyday. This means that we run on generator. There's no way we can work on generator 24 hours a day that the generator will last. And, virtually, every time, we use our money to buy diesel. We are not connected to public water, that means we depend on borehole and surface tanks. Ideally, these are the things (electricity and water) we are not supposed to be thinking about, we are supposed to take them for granted. Our other challenge is poor access road to the hospital. We have made several efforts to expand the road from Oyun Bridge to this place.

This teaching hospital recently performed some feat. What are they all about? We are at the stage of making UITH the hospital for the future. Recently, we did a renal transplant and, about three or four weeks ago, we did another one. We did an open heart surgery few months ago. We are partnering with an institution in India whose experts are coming around to train our staff. When the training is over, our staff would have been skilled enough to do some of these things on their own. We are also working on brain transfer. It is about sickle cell anaemia which will allow the transfer of patients brains so that they can live normal lives. We have link with an hospital in Saudi Arabia,hopefully, before the end of this year, we should be able to do that. What are your other achievements? We did talk about renal transplant, meaning that we have been able to transfer kidney from one person to another. The patients and the persons that donated the kidneys are doing well. We have done other advanced surgeries such as neck surgeries,spine surgeries,appendix that we have not done before.